Getting less attention: the people who don't visit doctors on religious grounds. Should they, too, be required to buy a policy they feel compelled not to use?

In the debate, the agenda of Christian Scientists, many of whom look to prayer rather than medicine for healing, is raising interesting questions about the lines between church and state.

Some of the bills advancing in the House and Senate would exempt religious objectors from mandates to obtain health coverage. More controversial is Christian Science's wish to see its prayer-based healing approach covered like conventional medical treatment. And they want spiritual options to be available to all Americans, not just those who follow their religion.

"It's so important that anyone in this country, not just Christian Scientists, not be discriminated against because they use spiritual care or rely on it instead of conventional medical treatment," said Phil Davis, who manages media and legislative affairs for Christian Scientists globally.

Religious exemptions

The Church of Christ, Scientist does not require its members to forgo medical treatment but promotes prayer as a route to healing, a philosophy rooted in the healing ministries of Jesus Christ.

Legal scholar Marci Hamilton has no problem with adults declining medical treatment for religious reasons, but she worries some of the proposed language could let parents to opt out of health coverage for their children.

"That's another reason they may not take the children to the hospital when they become very ill," said Hamilton, an expert in law and religion at Cardozo School of Law, a nondenominational affiliate of Yeshiva University. "The federal government should not be in the business of providing incentives for parents not to treat children."

While enforcement could be difficult, no one knows how widely this loophole could be embraced. It's among several opt-out possibilities. An exemption for financial hardship, for example, is also under discussion in Congress.

"It's not clear how many people would be wanting to be opting out of this particular system if the cost is you're left with essentially no care," said George Washington University.

In Massachusetts, which has included a religious exemption in its experiment with near universal health coverage, fewer than 10,000 tax filers claimed it in 2007, according to the most recent information from the state Department of Revenue.

Spiritual healing

The Massachusetts model is less than ideal to leaders of the Christian Science church, which has its headquarters in the state. The church, which says it does not keep numbers on the size of its national membership, would like to be included in the bigger health care overhaul, not just exempted out.

That would entail coverage under private and public health insurance for the work of 1,100 Christian Science "practitioners," professionals in the church who help others with prayer for healing, as well as its nurses and nursing facilities.

Christian Science practitioners do not operate directly out of the church, leaders say, but are screened through an application and discipline process set forth by the Christian Science Journal.

Religious leaders believe their practices can help not just devout Christian Scientists but any American interested in them.

"Many of the people that I've helped through prayer are not card-carrying members," said Davis, church spokesman and a Christian Science practitioner. "They are people who for one reason or another have found Christian Science effective, and they want that kind of care, that kind of health care approach."

Davis would not specify which pieces of legislation the church is supporting in Congress, where the bills are evolving rapidly.

Proposals that would advance the church's goals were included in legislation emerging from the House Energy and Commerce Committee, and other drafts of the health care overhaul.

"The biggest concern would be situations where the government is basically reimbursing people to engage in prayer services," he said.

His organization does not object to accommodations narrowly tailored around religious objections. Medicare, for example, allows some access to services like Christian Science nursing facilities for those who religiously object to medical care.

But Medicare, the government's health program for seniors, does not pay for the religious components of the healing.

Even that goes too far for American Atheists, an organization that opposes efforts to tack spiritual healing into health care reform.

"Faith healers are not practicing real medicine," spokesman David Silverman said. "The health care crisis is a very real problem, and we do not need the federal government coming in and saying that witch doctors or prayer is a real solution to a medical problem. It is not."

But Christian Scientists say they are a legitimate alternative.

"What we face in any mandated health care reform is: Will the public have access to something beyond conventional medical treatment?" Davis said. "Will the menu of options simply include a conventional approach or will there be other options, including spiritual care as taught in Christian Science?"

Times researchers Angie Holan and John Martin contributed to this report. Letitia Stein can be reached at lstein@sptimes.com or (813) 226-3322.